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Long term plan to 'guarantee' primary and community funding share - PM

Says long term plan will commit to primary and community care getting a ’growing share of spending’

Matt Hancock previously told HSJ this must begin in 2019-20, and not be delayed

Rapid response teams and health support in care homes are priority

The NHS long term plan will guarantee primary medical and community healthcare services “a growing share of overall NHS spending” over the next five years, the prime minister has announced.

Theresa May said in a statement that the money would contribute to spreading “community-based rapid response teams to care for those who would be better treated at home than in hospital”, and “national roll-out of support for care home residents”.

NHS England chief executive Simon Stevens said in the statement that ”as part of the NHS long term plan – for the first time we’re going to guarantee that these services get a growing share of the growing NHS budget”.

In an interview withHSJpublished last week, health secretary Matt Hancock said primary and community services’ share of the NHS budget had to increase, and that this“can’t wait” and should begin next year.

Today’s statement said the commitment was “worth £3.5bn a year in real terms by 2023-4”. It is not clear this figure would amount to a substantial increase the share of the overall budget, which is due to grow by about £20bn in real terms over the same period.

Little reliable data about primary and community spending is available although the Nuffield Trust, responding to the announcement, said 2017-18 spend on GP, primary and community was £21.7bn. This means the promised £3.5bn is “broadly in line with the 3.4 per cent overall [annual growth] that the NHS in England is getting over the next five years”.

Nuffield senior policy analyst Sally Gainsbury said this meant that “far from representing a big shift in funding towards out-of-hospital services, this money will simply allow GPs and community services to keep up with demand over the next five years”.

She said: “In many ways this is unsurprising. There are many existing calls on the new money pledged by the prime minister, like getting waiting times back on track and upgrading mental health services. We’ve calculated this will leave relatively little for any significant reform over the next couple of years.”

The government has not been able to clarify the baseline spend, and NHS England has declined requests for these figures in recent years. It is thought the commitment is intended to apply only to community health and GP (primary medical) budgets - not community pharmacy or dentistry budgets.

The situation echoes concerns about the Chancellor’s announcement last month to “increase mental health investment by at least £2bn a year in real terms” over the same period, which itself would result in no growth in spend share. Claire Murdoch, NHS England’s national mental health director, subsequently emphasised the “at least” element of the commitment, implying the spending growth would be greater.

Ms May said in the statement: “Too often people end up in hospital not because it’s the best place to meet their needs but because the support that would allow them to be treated or recover in their own home just isn’t available…

“That’s why I’m announcing a major boost in funding for community healthcare, which will give more patients a genuine and high-quality alternative to hospital.”

Mr Stevens said: “We need to radically redesign how primary and community health services work together. For community health services this means quick response to help people who don’t need to be in hospital, as well as dissolving the 70-year-old boundary between GP practices and community nursing.

“But to will the end is to will the means. That’s why – as part of the NHS Long Term Plan – for the first time we’re going to guarantee that these services get a growing share of the growing NHS budget.”

The NHS listening events below are an important part of the pre-consultation work, and hopefully will be useful in us all being able to get our points across.

We do really need to have a healthcare services in east Kent redesigned and updated and fit for the future, and this process of getting it right has delayed the process. We in CHEK have called for the consultation to be carried out as soon as possible so that patients can benefit , but its needs to conclude with the right outcome, and stop the sticking plaster solutions that seemed to have been with us for the last twenty years.

It's not just about A&E or where they are its about improving healthcare for all services and for all patients.

The loss of the stroke services from the K&C last year is still of concern, and the consultation on the service removes them from other hospitals as well, including the QEQM which is a blow to the patients from Thanet, and they are making their views known.

CHEK has campaigned vigorously for services at the K&C to be returned from their temporary status, one being stroke, but we are also trying to be realistic.

If there is only going to be one HASU service in east Kent, and I know the debate is not over, then surely it needs to be in the center of east Kent at the K&C. This way at least it will be within acceptable travel times for the people of Thanet, Dover, Faversham, Ashford,and all those in between.

Ken Rogers

These listening events have taken place, we are awaiting news of two more events in Tenterden and Faversham

Dear colleague

You’re invited to public events to explore potential optionsfor changes to hospital and local care services

We are writing to invite you to give your views on potential options to improve hospital and local care services across east Kent. Please join us atone of eight public events between 30 October and 20 November.

The NHS and social care partners in east Kent want to improve services for local people. We want people to get as much care and support as possible from their GP practice and local health and care teams. And we want to make sure they can get the best, most effective, hospital care if they need it.

This is the next step in conversations we’ve been having with staff, patients and the public over recent years about why change is needed and how services could be improved.

Some changes are already happening, for example, it is now possible to pre-book evening and weekend appointments with GPs, nurses or other health professionals wherever you live in east Kent; we are joining up care for people with the most complex conditions and helping them to stay well and independent at home; and we are starting to hold more outpatient clinics in local communities.

You’ve told us you want to hear more about these changes and we will be doing just that, as well as getting your views on what more we could do to care for you closer to home.

Some of you will remember that two potential options to improve hospital care in east Kent were published last November. These public events will update you on the two options and gather your feedback to help shape the final proposals. Dates, times and venues of all eight meetings are listed below.

At the meetings we will explain:

the benefits change could bring

how services outside hospitals are developing to maximise the care people get locally

how the two options for hospital services might affect people across east Kent

the next steps towards public consultation.

These informal meetings with local communities ahead of any formal consultation next year are a chance for local people and organisations representing patients to hear more about our work so far and to help us understand the potential impact of the options we are looking at.

We want to continue to gather a range of insights on the latest phase of our work. These views will be considered by the joint committee of east Kent Clinical Commissioning Groups (CCGs), before it decides whether both options for changes to hospital services go forward for public consultation.

If you cannot make it to the events, more information about the proposals will be added to the CCG websites andwww.kentandmedway.nhs.uk/eastkentshortly and an online survey will be open from mid-October.

Comment from Vice Chair of CHEK

A big question has been going the rounds on social media: should the NHS accept the gift from a developer of land and a built shell for a brand-new hospital in Canterbury?

Developers’ are not seen in a good light by many people. As a former councilor I have had my run-ins with developers over the years, supporting local people against what we saw a totally inappropriate plans to build over the countryside.

I have anyway certain red lines which I would not be prepared to cross to support the offer in the case of the new hospital.NO to any transfer by the NHS of land it owns to the developer. NO to any arrangement whereby the developer gains a contract to provide out-sourced services for the local NHS.

There is a basic fact here which needs to be borne in mind. Canterbury City Council has not shown the Government that it has allocated enough land for housing for future years. It is under pressure to find that land. If it doesn’t ,then the legislation says that developers can pick their own sites without any control by the Council.

In this case any planning application for development would have to go through local democratic processes. The fact remains, this will be a matter for local councilors to decide—and there will be serious matters for local people to consider---loss of farmland near them, how the traffic is dealt with, as against the prospect of a new fit-for-purpose hospital. .Knowing the area as I do, the very least I would want to see in any development is play-space for children, and green areas to walk in.

But—is it morally wrong to accept a gift of land and hospital building from a developer? It is worth remembering that back in the 1930s the Kent and Canterbury Hospital was made possible by the gift of the land by the then landowners, the Mount family.I see no problem in a landowner and a developer donating to the NHS(for the benefit of local people)a considerable part of the profit made on sale and development of the land IF the decision is taken by democratic processes to allow it to happen, and so long as that donation is without conditions.

Chek has written to the new secretary of state for Health Matt Hancock to ask for an appointment to see him.

Following on from our visit to see his predecessor in November CHEK wants to keep the pressure up. We have also invited him down to see for himself what the problems are in east Kent.

The acute services were removed from the K&C last June and we are campaigning to bring them back. Some of those services are being consulted on now, but we need a consultation on all of the acute services, and where they should be in east Kent. The full consultation that is planned but delayed should be focused on the best place geographically for these services, and CHEK is adamant that has not changed in the last 20 years, and should be in the centre of east Kent at the K&C.

There is no doubt that our premises for acute care are requiring major works to bring them into modern sustainable estate, suitable for health care for the foreseeable future.

CHEK had a big campaign last year for a new hospital, and there is now an option on the table to accept the offer of a shell of a new hospital built on land adjacent to the present K&C. This would be at no cost to the NHS as it has been offered free by a developer. Why this has not been accepted since it was offered over 12 months ago is unacceptable. We are now told that a full consultation on acute hospital services will not take place until early 2019 which makes a decision not likely until the end of the year.

In the meantime the NHS are in danger are investing money in propping up services instead of looking at the big picture and taking the decisions now, which will benefit patients now. One of those services is the new stroke service and its one referred as consulting now. That consultation has ended and has been studied. The stroke unit for east Kent is seen as the William Harvey Hospital, and not the K&C or indeed the QEQM, that's because they were not included in the consultation, and in the case of the K&C illegality we believe.

Should the acute services be located at the K&C then we are told that a new consultation would be carried out to move the stroke services from the WHH to the K&C. This is a ridiculous waste of money the new HASU stroke services should be at the K&C whatever happens, and plans should be made to put it there now, then the patients of east Kent could look forward to a centrally located service that surely must be a benefit to patient outcomes.

A new hospital in the centre of East KENT is what CHEK is campaigning for, a hospital with all specialities under one roof including Trauma and Acute Mental Health beds. We still need hospitals at each end of East Kent though to continue offering services nearer to patients' homes once those who have needed the more specialist treatment can be sent to them if they are not fit enough to be sent home, along with those not requiring the more specialist care. A state of the art hospital would certainly attract new, well qualified staff to East Kent as did the establishment of the Post Graduate Centre at the Kent and Canterbury hospital way back 50+ years ago.

Unless and until such a new hospital is built along with more services provided in the community, the situation here in East Kent will only get worse with a growing population and more of us living longer with the increasing demands on the NHS this brings.

Very interesting meeting held last evening at the University of Kent to celebrate the 70th birthday of the NHS. This was addressed by an academic involved in research, the Head of HealthWatch and the Chair of the local Hospital Trust. The theme was the NHS, past, present and future. We were told the first person to live to 200 has already been born! Just imagine what the future needs of health and social care will be with extended life expectancy. We are not adequately coping now with those living to 100. I personally know a family cracking under the strain of doing that for a family member right now.

The NHS needs to be taken out of the political area. It should not be a battleground for in fighting between opposing political parties that has and continues to happen right now. Successive governments of different political colours have failed East Kent over the years. We have politicians here right now failing to look at the wider picture while the public who have elected them are having to bear the brunt of past failings to address the needs of health and social care.

A new state of the art hospital in the centre of East Kent is certainly one solution and we must continue our campaigning to achieve this however we need to have services removed 'temporally' from the K&C returned there immediately to ease some of the pressure this action has put on the hospitals in Thanet and Ashford. Along with this we need a massive overhaul with appropriate financial provision to provide more services in the community.

It was such a pity that Canterbury and Whitstable's MP got caught up in another almost daily occurrence of a major hold up on the M2/A2, that she did not get to the meeting to hear from the panel the present and future health and social care needs for her constituents and those of all the other local MPs.

A DHSC statement saidLondon Ambulance Service was using its £3.85m share to purchase 25 double crewed ambulances. Yorkshire Ambulance Service Trust plans to spend its £7.5m share on 62 double crewed ambulances.

Investment will also be used to support infrastructure at ambulance trust headquarters to allow better restocking and maintenance of vehicles, the DHSC said.

NHS England medical director for acute care Keith Willett said: “This additional investment will help ambulance trusts to deliver the quality of service and excellent patient outcomes that are at the heart of the ambulance response programme.”

Mr Barclay said: “In some of the most worrying and vulnerable moments in our lives, dedicated ambulance staff are there, providing expert, calm and reassuring care to patients in often highly pressurised and sometimes dangerous situations.”

Other schemes to get funding included:

East of England Ambulance Services Trust: £6.5m for modification of ten of the eighteen key sites to support services for winter 2018-2019.

Dr Cornwall added: “As a first step, we need NHS England to introduce that target and measure and report on how well services meet it.

“Crisis teams are under pressure because resources have been diverted from core community mental health teams – the teams which prevent people getting into crisis.”

NHS England has set up a national team focusing on community mental health pathway. HSJ understands the national commissioning body is also looking at caseload sizes and response times for CRTs.

The survey was published in May and carried out by a team led by Brynmor Lloyd-Evans, senior lecturer in mental health and social care at University College London.

Dr Lloyd-Evans toldHSJa new four hour target was needed, and added: “The problems have always been there. The story is they have never quite been fully set up and implemented as planned.

“I think that guidance has really stood the test of time, it was based on really good models of care.

“What people want a good crisis team to look like is still what that model spells out.”

An NHS England spokesman said that since the survey was carried out in 2016 there had been £400m invested in improving services.

He added: “NHS England is rebuilding mental health crisis teams after years of underinvestment. Since 2016 when this survey was carried out, services have been improving as part of a £400m investment programme which will give people in every part of the country access to these crucial services.”